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Menstrual Disorders Flashcards

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1
Q

avg age of menarche…

A

12-13 yo

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2
Q

average menstrual cycle length (1st day of bleeding through next cycle of bleeding)

A

24-38 days

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3
Q

normal menstrual bleeding should be how long…

A

8 or fewer days

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4
Q

amount of blood loss in menstrual bleed?

A

5-80mL

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5
Q

The normal menstrual cycle depends on normal function of what three factors?

A

Hypothalamic-pituitary-ovarian axis

endometrial hormone response

intact outflow tract

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6
Q

Failure to reach menarche by age 15 with normal secondary sex characteristics

OR

by 13 without secondary sex development

A

primary amennorhea

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7
Q

absence of menses for more than 3 cycles or 6 consecutive months

A

secondary amenorrhea (cessation)

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8
Q

2 most common etiologies of primary amenorrhea…

A

gonadal dysgenesis and PCOS

ovarian dysfunction

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9
Q

what results in high FSH hypergonadotropic hypogonadism?

A

gonadal dysgenesis

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10
Q

what type of gonadal dysgenesis?

ovaries unable to respond to gonadotropins

MC cause of premature ovarian insufficiency

A

turner syndrome (45 XO)

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11
Q

What type of gonadal dysgenesis?

vanishing testes:
streak gonads don’t secrete AMH or T

A

46 XY

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12
Q

A patient presents with:

-premature depletion of oocytes and follicles

  • shield chest
  • webbed neck
  • side spaced nipples
  • streaked ovaries
A

Turner syndrome (45 XO)

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13
Q

A patient presents with:

indifferent gonads

female internal and external genetalia

no secondary male characteristics

rare d/o

A

46 XY, sawyer syndrome

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14
Q

46 XY is caused by…

A

SRY gene mutation

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15
Q

Patient presents with:

ovulatory dysfunction
hyperandrogenism

A

PCOS

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16
Q

If sxs of hypogonadotropic hypogonadism presents with anosmia, what should you suspect?

A

Kallman syndrome: congenital GnRH deficiency

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17
Q

Primary amenorrhea can be caused by hypothalamic disrutions. What is the female athlete triad?

A

insufficient calorie intake
amenorrhea
low bone density

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18
Q

2 pituitary causes of primary amennorhea

A

adenoma

hyperprolactinemia

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19
Q

This is an outflow tract d/o that is a common cause of primary amennorhea:

blind end vagina
cyclic pelvic pain and mass
normal gonadal function
breast development

A

mullerian agenesis

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20
Q

this is a congenital absence of oviducts, uterus and upper vagina with 46 XX genotype

A

mullerian agenesis

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21
Q

46 XY
female phenotype
high serum T

A

androgen insensitivity syndrome

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22
Q

testes make T and AMH but not responsive to T or DHT due to complete or partial androgen receptor insensitivity

A

androgen insensitivity syndrome

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23
Q

on US you notice absent upper vagina, uterus and fallopian tubes.

Physical exam reveals intra-abd or partially distended testes

A

androgen insensitivity syndrome

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24
Q

46 XY
can’t convert T to DHT
ambiguous genitalia at birth

A

5 alpha reductase deficiency

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25
Phenotypic female with HTN and lack of pubertal development decreased cortisol and sex steroids
17 alpha hydroxylase deficiency
26
which gene mutation causes 17 alpha hydroxylase deficiency?
CYP17
27
MC cause of secondary amennorhea...
pregnancy
28
initial workup of primary amenorrhea...
``` HCG FSH TSH Prolactin Pelvic US ```
29
If primary amenorrhea and absent uterus, what two tests should be ordered?
karyotype | total T
30
3 tx goals of primary amenorrhea...
underlying cause fertility complication mgmt (osteoporosis)
31
Negative pregnancy test history of wt. loss, strenuous exercise, eating d/o
hypothalamic dysfunction (anorexia, bulimia, exercise, stress)
32
negative pregnancy test hx of uterine surgery or infx scarred endometiral lining
asherman syndrome
33
Negative pregnancy test HA Visual Changes galactorrhea (2)
sheehan syndrome infiltrating pituitary dz/tumor
34
negative pregnancy test ``` worsening acne hirsutism wt. gain insulin resistance abnormal ovaries on US androgen excess ```
PCOS
35
negative pregnancy test recent or recurrent meds (OCPs, danezol, andipsychotics)
post pill amenorrhea DA/gonadotropin/releasing hormone antagonists
36
negative pregnancy test hx of: renal failure, CA, infx, RA
amenorrhea due to systemic illness
37
negative pregnancy test worsening acne hirsutism wt. gain
hypothyroidism
38
Evaluate for cause of primary amenorrhea when? (3)
no uterine bleeding by 15 no menses/thelarche by 13 no menarche w/in 3 years of thelarche
39
what DDx for primary amenorrhea? Low/normal FSH, (+) breast development and uterus present
PCOS/thyroid
40
What tests should be ordered for primary amenorrhea for the below results and why? L ow/normal FSH, (+) breast development and absent uterus:
DDx: mulerian agenesis order karyotype, T r/o AIS
41
What course of action? L ow/normal FSH, ( (--) breast development
pituitary MRI
42
if pituitary MRI is negative and normal prolactin... what two tests should be ordered?
transferrin saturation (hemochromotosis) Progesterone challenge
43
If low FSH/no estrogen or no withdrawal bleed on progesterone challenge, what type of amenorrhea should be considered?
functional hypothalamic
44
If unopposed estrogen/high LH to FSH ratio and withdrawal bleed on estrogen challenge, what type of amenorrhea should be considered?
PCOS
45
Initial workup for secondary amenorrhea
``` HCG FSH TSH prolactin T ```
46
the below are most common causes of.. anovulation structural pathology bleeding disorder uterine neoplasia
abnormal uterine bleeding
47
The PALM-COEIN Classification seeks to differentiate what?
structural/nonstructural cause of AUB
48
The below are ____ causes of AUB polyp adenomyosis leiomyoma (fibroid) malignancy
structural
49
The below are ____ causes of AUB ``` coagulopathy ovulatary dysfunction endometrial iatrogenic not classified ```
nonstructural
50
MC cause of AUB for 13-18 yo
anovulatory bleeding via immature HPO axis
51
common cause of AUB for 19-39
structural leisions
52
common cause of AUB for 40 to menopause
anovulatory bleeding, carcinoma, hyperplasia
53
unpredictable bleeding is suggestive of what type of AUB?
anovulatory
54
regular cycle length and associated with sxs of ovulation is what type of AUB?
ovulatory
55
heavy AUB is usually what cause?
uterine (fibroid, adenomyosis, coagulopathy)
56
the below often cause what type of AUB? polyp contraception PID cervical d/o
intermenstrual
57
post-coital bleed should be sugestive of _____ pathology
cervical
58
irregular/anovulatory bleed is likely due to (3)
PCOS thyroid hyperprolactinemia
59
T/F: any post-menopausal bleed is abnormal
tru
60
if a patient with AUB is hemodynamically unstable, what is tx?
admit for IV estrogen
61
the below is a cause of: PGs released from endometrium cause uterine contractions/ischemia
primary dysmenorrhea
62
Patient presents w. normal pelvic exam cramp like, intermittent pain onset hours before or just after onset of menstruation
primary dysmenorrhea
63
how is primary dysmenorrhea diagnosed?
clinical (if h & p consistent)
64
Tx for primary dysmenorrhea...
ibuprofen 400mg q 4-6 hours x 3-4 days hormonal contraceptives
65
The below complications are indications for... ```  Pain worsening with each menses  Pain lasts longer than first 2 days of menses  Medication is no longer controlling the pain  Menstrual bleeding becomes increasingly heavy  Pain accompanied by fever  Abnormal discharge or bleeding occur  Pain occurs at times unrelated to menses ```
referral
66
resistant primary dysmenorrhea can be treated with...
laproscopy GnRH analogue
67
30-40 yo pt presents with: pain not limited to menses dyspareunia infertility AUB
secondary dysmenorrhea
68
the below are common causes of... ```  Endometriosis (presence of endometrial tissue outside the uterus)  Adenomyosis (endometrium grows into the wall of the  Adhesions  Pelvic inflammatory disease (PID)  Leiomyomas (uterine fibroid ```
secondary dysmenorrhea
69
tx for secondary dysmenorrhea...
underlying cause +/- hormone therapy
70
PMS is related to the _____ phase
luteal phase
71
what Nt is decreased in the luteal phase that may be responsible for PMS/PMDD due to progesterone's increase of MAO
serotonin
72
A patient presents with: irritability, depression, anxiety, sensitivity increased appetite bloating fatigue breast tenderness HA
PMS
73
PMS can be diagnosed if what two factors...
1+ sx occurs during luteal phase sxs remit at menses
74
PMDD requires ____/11 sxs present during____
5 during most menstrual cycles
75
the below are sxs of ____ mood swings hopelessness anger anxiety AND sxs of depression (DIGFAST)
PMDD
76
PMS, PMDD, or MDD? +/- predominant mood sxs + physical sxs - social impairment monthly cycle
PMS
77
PMS, PMDD, or MDD? + predominant mood sxs + physical sxs + social impairment + monthly cycle
PMDD
78
1st line therapy for PMDD
SSRIs

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